Several bridges cross the River Esk, but in Musselburgh alone, there are seven bridges connecting the town with Fisherrow on the opposite bank. There were three large mills and several smaller mills, tanneries and other industries powered by the river. The weir which provided the head of water to power these mills is known locally as The Falls. The Musselburgh Paper Mill operated from the 1870s until its closure in 1971. Further downstream was the Net Mill where in 1820 James Paterson invented the mechanical net loom to replace the manual process. Bruntons internationally famous Wiremill, founded in 1876, also occupied a huge site by the river. They rigged the first airships and many suspension bridges were cabled by Bruntons including the Forth Road Bridge. The iron footbridge was built in 1923 to carry workers across the river to these mills. The former railway viaduct, built in 1877 was replaced some years ago by a road bridge.

Further downstream is the Old Bridge, known as the Roman Bridge though the foundations were built over with a two arch structure in mediaeval times, the third arch being added in 1597. In 1296, the Old Bridge carried the Scottish army marching to the Battle of Dunbar and in 1314, the English army crossed it following its defeat at Bannockburn. While crossing the bridge after the Battle of Pinkie in 1547, several of the Scottish army were killed by shot from the English ships lying off the mouth of the Esk. The sea has receded considerably since then!! Charles Edward Stuart led his Highland army across the bridge to the Battle of Prestonpans in 1745, and again in triumphant return to Edinburgh.

Until the old railway bridge was opened as a road bridge, the New Bridge, designed by John Rennie in 1806 and widened in 1925, carried the A1 through the town. Beside it on one side, is the Delta Memorial to the poet, author and physician, David Macbeth Moir (1798-1851) and opposite, the Fountain gifted to the town in the 1890s and restored as a Second World War Memorial in 1999. Opposite, the High Kirk, built in 1843, is now the Musselburgh Museum of Dolls and Art Exhibits. Since 1987, the A1(T) has bypassed Musselburgh.

The footbridge called the 'Store' Bridge, connecting Shorthope Street and North High Street where the former Cooperative buildings were sited, is beside the old fording place. There are usually nesting swans on the small islands in the river but the Esk Estuary is host to numerous swans during the moulting season. The Electric Bridge was built in the 1960s to carry the huge turbines being installed at Cockenzie Power Station but when it was no longer needed, Musselburgh Town Council declined the offer of the Electricity Board to make it available for all to use and it is now only occasionally open to traffic. The last bridge to cross the river is a footbridge. A series of 'lagoons' were constructed on the links at Musselburgh for the disposal of waste ash from Cockenzie. Managed as a Bird Reserve, birdwatchers can see an amazing variety of birds at any time of the year.

Fisherrow is thought to have had a harbour on the opposite side of the river since Roman times, the boats fishing for white fish and herring. The Fisherrow fishwives in their distinctive blue and white striped dresses were a familiar sight in the streets of Edinburgh carrying their wicker creels.